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Neuro > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS

A

chronic and debilitating disease that results from demyelination of the CNS

onset between 20-40 y/o

sclerotic plaques form throughout brain and spinal cord

charcots triad: intention tremor, scanning speech and nystagmus

presentations of symptoms not consistent from one pt. to another

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2
Q

pathophysiology

A

most accepted theory is that some environmental trigger, virus, causes a delayed autoimmune attach in genetically susceptible people

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3
Q

what occurs with MS

A

patches of demyelination occurs in the white matter of brain and SC-> destruction of oligodendrocytes= myelin producers

inflammation accompanies that destruction of myelin shealth and can lead to axon damage and plaque formation

plaque replaced by scar tissue produced by GLIAL CELLS

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4
Q

what are glial cells

A

what produces the plaque on scar tissue in MS and causes degeneration of trapped axons

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5
Q

what areas of nervous system are most likely affected

A

optic nerve

periventricular white matter

corticospinal tracts

posterior columns

cerebellar penducles

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6
Q

clinical manifestations

A

sensory changes
pain
visual disturbances

motor dysfunction-impairment

ambulation
speech and swallowing dysfunction

cognitive and affective changes

autunomic changes

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7
Q

Sensory Changes

A

paresthesia-pins and needles sensation

typically first signs

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8
Q

Visual changes

A

optic Neuritis: blurring, loss of vision, pain on eye movement

Scotoma: blind spot

NYstagmus: rapid, alternating oscillations of the eyes

internuclear ophthalmoplegia: lateral gaze palsy

diplopia: double vision

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9
Q

Pain

A

trigeminal Neuralgia: short attacks of severe facial pain

Lhermitte’s Sign: sensation like electric shock running down the spine and into limbs, produced by flexing nek

hyperpathia: hypersensitivity to light touch or pressure stimulus

chronic neuropathic pain-burning pain

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10
Q

UMN Weakness and fatigue

A

Weakness/paresis- mild to total

fatigue-persistent, loss of energy, limited tolerance to ex

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11
Q

spasticity

A

UMN

occurs 80%

varies from mild to severe

may include: Conus, spontaneous, positive Babinski

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12
Q

Balance and Coordination

A

ataxia-uncoordinated movements

dysmetria: inability to judge distance or ROM
dysdiadochkineisa: inability to alt. movements rapidily
dyssynergia: impaired ability to perform movements in a complex movement or associate together

Postural tremor: shaking, back and forth oscillatory movements

Intention Tremor: vary from slight to severe during voluntary movements

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13
Q

Ambulation

A 
weakness/paresis
fatigue
spasticity
impaired sensastion
visual problems
ataxia
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14
Q

speech and swallowing

A

dysarthria: slurred or poorly articulated speech
* *slow rate, low volume and unnatural emphasis

dysphonia: changes in vocal quality
* hasness, hoarseness, breathiness, hypernasal sounds

Dysphagia: difficulty in swallowing

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15
Q

Cognitive and affective Change

A

mild to mod. impairments
depression
affective changes
**pseudobulbar affect: sudden loss of emotional control=emotional lability
**euphoria: exaggerated feeling of well being

  • cognitive inflexible-caused by lesions in frontal lobe=unable to change or adapt
  • -loss of ability of judgement and reasoning
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16
Q

Fatigue

A

most frequently reported symptom
persistent and loss of energy
limited tolerance to ex
worsened by heat

can affect ability to complete ADL’s

17
Q

autonomic changes

A

Urinary and bowel issues
cardio dysautonomia
sexual dysfunction

18
Q

Motor Features

A

clumsiness in reaching and over shooting target
postural tremor of extremity or trunk in sitting or standing
scanning speech is slow with long pauses and lacks fluidity
increased risk of aspiration
gait is characterized by poor balance and lurching

19
Q

Relapsing-remitting Course

A

periods of exacerbations and remissions
occur when sympotms worsen acutely and thenr emit or recover with time of symptom stability
intervals btw. exacerbation may initially be a year or more at beginning of the disease
-intervals may shorten as the disease progresses

20
Q

Primary Progressive

A

relentless progression without any relapses

21
Q

secondary progressive

A

begins w/ relapse and remissions but then becomes progressive with only occasional relapses and minor remissions

22
Q

progressive relapsing

A

progressive from onset but has clear acute exacerbations with and without full recovery

23
Q

benign

A

describes clinical course in which symptoms progress very little over the span of the persons life

24
Q

malignant

A

progressing symptoms that quickly result in disability and death

25
Q

diagnosis based on

A

clinical evidence of multiple lesions in CNS white matter

distinct time intervals

occurence in indiviuals btw. ages of 10 and 50 yrs old

CSF examined for higher amounts of gamma globulin and myelin protein

26
Q

4 injectable drugs

A

reduce frequency of attacks as well as disease progression

  1. Copaxone- synthetic compound made of amino acids– reduce inflammation at lesions sites by stimulating T cells to increase anti inflammatory agents
  2. interferons
    - avonex
    - betaseron
    - rebif
27
Q

6 PT goals

A
  1. minimize progression
  2. maintain an optimum level of functional independence
  3. prevent or decrease secondary complications
  4. maintain respiratory function
  5. conserve energy and maintain energy levels
  6. educat pt. and family
28
Q

sensory deficits

A

diminished sensation=retraining via stimulation tech
proprioceptive loss
blurred vision
double vision

29
Q

skin care prevention

A

skin should always be kept clean
good diet and fluids
inspect skin daily
clothing should be breathable and comfortable
provide regular skin relief
-move every 2 hours lying and 15 minuntes sitting

30
Q

management of pain

A

chronically weakened muscles
pain due to malalignment
stabbing pain from L hermitte’s sign-relieved with soft collar to limit neck flexion
painful dysesthesias

31
Q

Exercise Training

A

schedule sessions on alternate days and times
sub max ex around 60-75% peak HR or 50-60% VO2 max
alternate work btw. UE and LE
balance ex with adequate rest periods
Slow progression
exercise to point of fatigue is contracindicated
monitor effects of fatigue
manage core body temp and prevent over heating

Neuro (11 decks)

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